Hospital Israelita Albert Einstein, MDP Ecocardiografia, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2013 Jun;100(6):524-30. doi: 10.5935/abc.20130099. Epub 2013 May 10.
Assessment of the right ventricular (RV) function by echocardiography in patients with pulmonary thromboembolism (PTE) is complex and frequently qualitative. Tissue Doppler has been used for the semiquantitative assessment of this chamber, although with some limitations.
To evaluate RV function in PTE using tissue-Doppler echocardiography, in addition to atrial natriuretic peptide (BNP).
Patients with PTE were studied using tissue-Doppler echocardiography and BNP up to 24 hours after diagnosis; myocardial velocities (s'), strain, strain rate and RV myocardial performance index were obtained. RV dysfunction was diagnosed by chamber hypokinesia, abnormal septal motion and a RV/LV ratio >1. According to their BNP levels, the patients were divided into Group I, BNP < 50 pg/mL and Group II, BNP > 50 pg/mL.
Of 118 patients, 100 (60 men, age = 55 ± 17 years) were analyzed; RV dysfunction was observed in 28%, more frequently in group II (19 vs. 9 patients, p < 0.001). Patients in group II were older (64 ± 19 vs. 50 ± 15 years), and had lower s' velocity (10.5 ± 3.5 vs. 13.2 ± 3.1 cm/s), and higher pulmonary pressure (48 ± 11 vs. 35 ± 11 mmHg), p < 0.001. The cut-off point of s' for RV dysfunction was 10.8 cm/s (specificity = 85%, sensitivity = 54%), with moderate correlation between BNP and s' wave (r = -0.39).
In PTE, RV dysfunction on echocardiography is accompanied by BNP elevation; although tissue-Doppler imaging adequately confirms the presence of RV dysfunction, it has a limited sensitivity for this diagnosis.
超声心动图评估肺血栓栓塞症（PTE）患者的右心室（RV）功能较为复杂，且通常为定性评估。组织多普勒已用于该腔室的半定量评估，但存在一些局限性。
使用组织多普勒超声心动图评估 PTE 患者的 RV 功能，并结合心房利钠肽（BNP）进行评估。
对 PTE 患者进行组织多普勒超声心动图和 BNP 检查，检查时间在诊断后 24 小时内；获取心肌速度（s'）、应变、应变率和 RV 心肌做功指数。通过心室运动减弱、室间隔运动异常和 RV/LV 比值>1 诊断 RV 功能障碍。根据 BNP 水平将患者分为 I 组（BNP<50pg/ml）和 II 组（BNP>50pg/ml）。
共纳入 118 例患者，其中 100 例（60 例男性，年龄=55±17 岁）进行了分析；28%的患者存在 RV 功能障碍，II 组更为常见（19 例 vs. 9 例，p<0.001）。II 组患者年龄更大（64±19 岁 vs. 50±15 岁），s'速度更低（10.5±3.5cm/s vs. 13.2±3.1cm/s），肺动脉压更高（48±11mmHg vs. 35±11mmHg），p<0.001。s'用于 RV 功能障碍的截断值为 10.8cm/s（特异性=85%，敏感性=54%），s'波与 BNP 之间存在中度相关性（r=-0.39）。
在 PTE 中，超声心动图显示 RV 功能障碍时 BNP 升高；尽管组织多普勒成像充分证实了 RV 功能障碍的存在，但对该诊断的敏感性有限。
